Flashcards in Intracranial haemorhage Deck (30):
1
What are the different types of spontaneous intracranial haemorrhages?
SAH
Intracerebral
Intraventricular
2
What is SAH?
Bleeding into the SAH
Usually underlying berry aneurysm
Sometimes AVM
Trauma
3
What is the clinical presentation of SAH?
Sudden onset severe headache
Collapse
Vomiting
Neck pain
Photophobia
4
DDx of sudden onset headache
SAH
Migraine
Benign coital cephalgia
5
What are the signs of SAH?
Neck stiffness
Photophobia
Decreased conscious level
Focal neurological deficit (dysphagia, hemiparesis, 3rd nerve palsy)
Fundoscopy; retinal or vitreous haemorrhage
6
What is the initial investigation in a suspected SAH?
CT scan
7
What will an LP show in SAH?
Bloodstained or xanthochromic CSF (6-48 hrs)
8
How is cerebral angiography performed?
Seldinger technique via femoral artery
Digital subtraction
9
What is the gold standard in SAH?
Cerebral angiography/ CTA
10
Why can cerebral angiography miss an angiography?
Vasospasm; all patients with SAH will be give nimodipine
11
What are the complications post SAH?
Re-bleeding
Delayed ischaemic deficit
Hydrocephalus
Hyponatremia
Seizures
12
What can be done to help prevent re-bleeding in SAH?
Endovascular techniques
Surgical clipping
13
When does delayed ischaemic neurological deficit tend to occur?
Days 3-12
14
What can be done to help prevent delayed ischaemia?
Prevent vasospasm; nimodipine
Triple H therapy; hypervolaemia, hypertensive, daemodilation
15
What is the treatment for hydrocephalus?
CSF drainage via:
LP
EVD
Permanently; shunt
16
What can cause hyponatremia?
SIADH
Cerebral salt wasting
17
Do you fluid restrict for hyponatremia in SAH?
NO; supplement sodium intake or give fludrocortisone
18
Is the seizure risk increased acutely and post SAH?
Yes; some will give anticonvulsant prophylaxis
19
What should the initial treatment and investigations be in SAH?
Bedrest
Analgesia
Anti-emetic
IV fluids
CT scan brain
LP
Refer to neurosurgeons
20
What is the commonest cause of intracerebral haemorrhage?
Secondary hypertension
21
What is the pathogenesis of hypertensive ICH?
Charcot-bouchard microaneurysms arising on small perforating areas
22
Which area of the brain is most commonly affected by hypertensive ICH?
Basal ganglia and internal capusle
23
What is the presentation of an ICH?
Headache; not as sudden onset or as severe as SAH
Focal neurological deficit
Decreased conscious level; increased ICP leads to reduced CCP
24
What are the recommended investigations of an ICH?
CT scan; URGENT if decreased GCS
Angiography if suspicion of underlying vascular anomaly
25
What is the treatment of an ICH?
Surgical evacuation of haematoma +/- treatment of underlying abnormality
Non-surgical management; if haemorrhagic stroke refer to stroke team
26
What is the prognosis post ICH?
Good; if small superficial clot
Poor; if large basal ganglia or thalamic clot with major focal deficit or deep coma
27
When do intraventricular haemorrhages occur?
Rupture of subarachnoid or intracerebral bleed into a ventricle
28
Where will blood tend to pool in intraventricular haemorrhages on CT?
Occipital horns of lateral ventricles
29
What can AVMs cause?
Seizures
Haemorrhage; ICH, SAH, subdural
Headache
Steal syndrome
30